Chapter 07: Adaptive Immunity

Power-Kean et al.: Huether and McCance’s Understanding Pathophysiology, Second Canadian Edition

MULTIPLE CHOICE

1. Which of the following is responsible for initiating clonal selection?

a. T cells
b. B cells
c. Antigens
d. Lymphocytes
ANS: C
The lymphocytes remain dormant until an antigen initiates clonal selection. T cells do not initiate clonal selection. B cells are
antibodies. Lymphocytes are released into the circulation as immature cells that react with antigens.

DIF: Cognitive Level: Understand REF: Third Line of Defence: Adaptive Immunity
TOP: Physiological Integrity

2. Which following patient will develop active immunity?

a. The patient who has natural exposure to an antigen
b. The patient who receives preformed antibodies or T cells from a donor
c. The patient who has T cells that transform to B cells
d. The patient that receives immunoglobulin
ANS: A
Active immunity occurs after natural exposure to an antigen, not with preformed antibodies, or the transformation of T cells into B
cells, or as a result of receiving immunoglobulin.

DIF: Cognitive Level: Understand REF: Third Line of Defence: Adaptive Immunity
TOP: Physiological Integrity

3. An experiment is designed to determine specific cell types involved in cell-mediated immune response. The experimenter is
interested in finding cells that attack cells that have specific antigens. Which cells should be isolated?
a. Lymphokine-producing cells
b. T-cytotoxic cells
c. Helper T cells
d. Macrophages
ANS: B
Cell-mediated immunity is driven by T-cytotoxic (Tc) cells that attack antigens directly and destroy cells that bear foreign antigens.
Lymphokine-producing cells, helper T cells, and macrophages do not attack antigens directly and destroy cells that bear foreign
antigens.

DIF: Cognitive Level: Understand

REF: Third Line of Defence: Adaptive Immunity | Figure 7.1 TOP: Physiological Integrity

4. A 6-year-old patient is diagnosed with a bacterial infection of the respiratory system. Which of the following will most likely try to
fight the antigen?
a. Antibodies
b. Cytotoxic T cells
c. Self-antigens
d. Helper T cells
ANS: A
Antibodies are produced by plasma cells that mature from lymphocytes, called B lymphocytes (B cells), in response to an antigen.
Cytotoxic T cells do not respond to antigens. Self-antigens do not respond to antigens. Helper T cells do not respond to antigens.

DIF: Cognitive Level: Understand

REF: Antigens and Immunogens | Functions of Antibodies TOP: Physiological Integrity

5. What is the most abundant class of antibody found in serum?

a. IgG
b. IgM
c. IgA
d. IgE
ANS: A
IgG is the most abundant class of immunoglobulins, constituting 80 to 85% of the immunoglobulins in the blood.

DIF: Cognitive Level: Understand REF: Classes of Immunoglobulins

TOP: Physiological Integrity

Copyright © 2023, Elsevier Inc. All rights reserved. 1

 6. The predominant antibody of a typical primary immune response is:
a. IgG.
b. IgM.
c. IgA.
d. IgE.
ANS: B
IgM is the largest immunoglobulin and is the first antibody produced during the initial, or primary, response to antigen.

DIF: Cognitive Level: Understand REF: Classes of Immunoglobulins

TOP: Physiological Integrity

7. A nurse is caring for a patient with a severe pulmonary infection. While planning care, which immunoglobulin will the nurse
remember as the most important component of pulmonary secretions?
a. IgA
b. IgB
c. IgP
d. IgM
ANS: A
IgA is the secretory immunoglobulin, found in the secretions of the gastro-intestinal, pulmonary, and genitourinary systems. IgM,
while found in some secretions, is not as prominent as IgA. IgB and IgP do not exist.

DIF: Cognitive Level: Understand REF: Classes of Immunoglobulins

TOP: Physiological Integrity

8. A 23-year-old pregnant patient with female genitalia visits the primary care provider for a final prenatal checkup. The primary care
provider determines that the fetus has developed an infection in utero. Which of the following would be increased in the fetus at
birth?
a. IgG
b. IgA
c. IgM
d. IgD
ANS: C
IgM is synthesized early in neonatal life, and its synthesis may be increased as a response to infection in utero.

DIF: Cognitive Level: Understand REF: Classes of Immunoglobulins

TOP: Physiological Integrity

9. Which portion of the antibody is responsible for most of the biological functions of antibodies?
a. Heavy chain
b. Variable region
c. Fc portion
d. Epitope
ANS: C
The Fc portion is responsible for most of the functions of antibodies. The other portions of antibody act to support the structure and
functions of the Fc portion.

DIF: Cognitive Level: Understand REF: Molecular Structure | Figure 7.5

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10. A 25-year-old patient with female genitalia has sexual relations with their partner. Later the patient is told that the partner is
infected with Neisseria gonorrhoeae. Testing reveals that the patient does not have the disease. How is it possible that the patient
did not contract the disease?
a. Antibodies covered sites of attachment on the microorganisms.
b. The patient was vaccinated against it.
c. Platelets provided protection.
d. IgE was released.
ANS: A
Some bacteria, such as Neisseria gonorrhoeae that causes gonorrhea, must attach to specific sites on urogenital epithelial cells.
Antibodies may protect the host by covering sites on the microorganism that are needed for attachment, thereby preventing
infection. Neither a vaccination, the protection of platelets, nor the release of IgE was relevant to the patient’s ability to avoid
contracting this disease.

DIF: Cognitive Level: Understand REF: Functions of Antibodies

TOP: Physiological Integrity

11. A patient has a disease state that results from the secretion of toxins by bacteria. Which medical diagnosis might the nurse see
documented on the chart?
a. Malaria
b. Tetanus
c. Smallpox
d. Hepatitis
ANS: B
Some bacteria secrete toxins that harm individuals. For instance, specific bacterial toxins cause the symptoms of tetanus or
diphtheria. Malaria is a parasitic disease, whereas smallpox and hepatitis are viral infections.

DIF: Cognitive Level: Understand REF: Functions of Antibodies

TOP: Physiological Integrity

Copyright © 2023, Elsevier Inc. All rights reserved. 2

 12. A 10-year-old child is stung by a bee while playing in the yard. The child experiences a severe allergic reaction and is taken to the
ER. The nurse providing care realizes that this reaction is the result of:
a. toxoids.
b. IgA.
c. IgE.
d. IgM.
ANS: C
IgE is normally at low concentrations in the circulation. It has very specialized functions as a mediator of many common allergic
responses. Neither toxoids, IgA, nor IgM is the mediator of common allergic response.

DIF: Cognitive Level: Understand REF: Classes of Immunoglobulins | Immunoglobulin E

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13. A patient has done research on monoclonal antibodies on the Internet. Which statement indicates a correct understanding? Pure
monoclonal antibodies are produced by:
a. T lymphocytes.
b. bone marrow.
c. laboratories.
d. fetuses.
ANS: C
Monoclonal antibodies are produced in the laboratory from one B cell that has been cloned; thus, the entire antibody is of the same
class, specificity, and function. Pure monoclonal antibodies are not produced by T lymphocytes, bone marrow, or fetuses.

DIF: Cognitive Level: Understand REF: Figure 7.1 TOP: Physiological Integrity

14. Which of the following is considered a secondary lymph organ?

a. The spleen
b. Bone
c. Antibody
d. The liver
ANS: A
The liver, bone, or antibody are not secondary lymph organs. The spleen and lymph nodes are all considered secondary lymphoid
organs.

DIF: Cognitive Level: Understand REF: Figure 7.1 TOP: Physiological Integrity

15. A 20-year-old individual is applying for nursing school and is required to be tested for immunity against several illnesses. Testing
that looks at which of the following would be the best to determine immunity?
a. Culture and sensitivity
b. Agglutination
c. Precipitation
d. Titre
ANS: D
The amount of antibody in a serum sample is referred to as the titre; a higher titre indicates more antibodies. Culture determines the
type of organism that causes an infection, and sensitivity identifies the antibody it is sensitive to. The terms agglutination and
precipitation are not used to identify a test to determine immunity.

DIF: Cognitive Level: Understand REF: Primary and Secondary Immune Responses
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16. A macrophage was isolated and analyzed for major histocompatibility complex. Which of the following would be expected?
a. MHC I only
b. MHC II only
c. MHC I and II
d. Neither MHC I nor MHC II
ANS: C
MHC I and II would be expected. MHC I and II are co-expressed on a limited number of cells, including macrophages.

DIF: Cognitive Level: Understand REF: Figure 7.14 TOP: Physiological Integrity

17. A 5-month-old child is admitted to the hospital with recurring respiratory infections. What is a possible cause of this condition?
a. Hypergammaglobulinemia
b. Increased maternal IgG
c. Immune insufficiency
d. Decreased maternal antibody breakdown, resulting in hyposensitivity
ANS: C
Normal human infants are immunologically immature when born, with deficiencies in antibody production, phagocytic activity,
and complement activity, especially components of alternative pathways. They do not possess hypergammaglobulinemia.
Possessing increased maternal IgG would not lead to recurring infections. The recurrent infections are due to decreased immunity,
not maternal antibody breakdown.

DIF: Cognitive Level: Understand REF: Pediatric Considerations Box

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 MULTIPLE RESPONSE

1. While planning care for a patient who is an older person, the nurse remembers that increased age is associated with which of the
following? (Select all that apply.)
a. Increased T-cell function
b. Decreased immune function
c. Increased production of antibodies
d. Decreased numbers of circulating immune complexes
e. Decreased ability to fight infection
ANS: B, D, E
Increased age is associated with diminished T-cell function, decreased immune function, diminished production of antibody
responses, decreased circulating immune complexes, and decreased ability to fight infection.

DIF: Cognitive Level: Understand REF: Geriatric Considerations Box

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2. What classes of immunoglobulins are known to exist? (Select all that apply.)
a. IgA
b. IgB
c. IgD
d. IgE
e. IgG
f. IgM
ANS: A, C, D, E, F
Only IgB is a nonexistent immunoglobulin.

DIF: Cognitive Level: Understand REF: Classes of Immunoglobulins

TOP: Physiological Integrity

3. The direct effects of antibodies include: (Select all that apply.)

a. neutralization.
b. agglutination.
c. precipitation.
d. phagocytosis.
e. division.
ANS: A, B, C
Directly, antibodies can affect infectious agents or their toxic products by neutralization (inactivating or blocking the binding of
antigen to receptors), agglutination (clumping insoluble particles that are in suspension), or precipitation (making a soluble antigen
into an insoluble precipitate). Indirectly, antibodies activate components of innate resistance, including complement and
phagocytes. Antibodies are generally a mixed population of classes, specificities, and capacity to provide the functions listed above.

DIF: Cognitive Level: Understand REF: Functions of Antibodies

TOP: Physiological Integrity

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